The diagnostic category includes any patient who presents with concern, their primary physician having a concern, or a concerning finding on their screening mammogram, hence, additional imaging is required. A diagnostic mammogram must be obtained with "direct supervision" of an interpreting physician so that all needed images for interpretation can be acquired during the patient's visit. Screening mammograms can be obtained without the presence of an interpreting radiologist. If there is any reason for concern such as pain, a palpable lump, or discharge the patient does not qualify for a screening mammogram and must be placed in the diagnostic category. A screening mammogram is for a patient that has no complaints as well as a normal examination by her primary care physician. A patient is placed in one of two categories: screen or diagnostic. The BI-RADS approach to mammography begins with an efficient and cost-effective categorization to mammograms. The latest edition is BI-RADS 5 (2013) and included six classifications for lesions. BI-RADS was built to be fluid and change with the adaptation of new techniques and research. Such changes that have occurred are the inclusion of lexicons for ultrasound in 2003 and MRI in 2006. The categorization and final assessment decreased ambiguity in recommendations. The categorization provides an approximate risk of malignancy to a lesion from essentially zero to greater than 95%. The second important aspect of the BI-RADS system was the category classification for the overall assessment of the imaging findings. The ACR used scientific analysis and literature review to create a lexicon of descriptors that had shown to correlate with high predictive values associated with either benign or malignant disease. The first version proposed included the suggested structure for a mammographic report, the lexicon for mammographic imaging findings, and final assessment category with recommendations for management. BI-RADS was implemented to standardize risk assessment and quality control for mammography and provide uniformity in the reports for non-radiologist. The 1980s saw an exponential increase in mammography with the implementation of yearly screening mammograms and overwhelming variation amongst radiology reports. Breast imaging-reporting and data system (BI-RADS) is a classification system proposed by the American College of Radiology (ACR) in 1986 with the original report released in 1993.
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